Trial reportImplementation science : IS2020
Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T
Trial report in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review.Implementation science : IS · 2023Pooled it
- Data-Driven Implementation Strategy to Optimise Clinician Behaviour Change at Scale in Complex Clinical Environments: A Multicentre Emergency Care Study.Journal of advanced nursing · 2025Trial
- Methods and processes to develop and deliver a theory-informed education program for sustained behaviour change in emergency nursing.PloS one · 2025Trial
- Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation.Implementation science : IS · 2024Trial
- Barriers to Protocol Adherence in Emergency Departments and Evidence-Based Strategies for Successful Implementation: A Scoping Review.Journal of clinical medicine · 2026Review
- Implementation evaluation of nurse-initiated care in 29 Australian emergency departments: a RE-AIM multi-method evaluation.Implementation science : IS · 2026Article
- Stroke Coordinators' Perspectives on Sustaining Use of Fever, Sugar (Hyperglycaemia) and Swallow (FeSS) Protocols. Process Evaluation Using a Sustainability Framework.Journal of advanced nursing · 2026Article
- Do process evaluations open up the 'black box' of implementation interventions in health care? A scoping review.Implementation science : IS · 2025Article
- Identifying Barriers and Enablers for Nurse-Initiated Care for Designing Implementation at Scale in Australian Emergency Departments: A Mixed Methods Study.Journal of clinical nursing · 2025Article
- Finding the right dose: a scoping review examining facilitation as an implementation strategy for evidence-based stroke care.Implementation science : IS · 2025Article
- Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research.Frontiers in health services · 2023Article
- Review article: A primer for clinical researchers in the emergency department: Part XII. Sustainability of improvements in care: An introduction.Emergency medicine Australasia : EMA · 2022Review
- Effect of the Growth Assessment Protocol on the DEtection of Small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial.Implementation science : IS · 2022Article
- Objective risk assessment vs standard care for acute coronary syndromes-The Australian GRACE Risk tool Implementation Study (AGRIS): a process evaluation.BMC health services research · 2022Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 13 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T
methodsQualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups.
resultsTwenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols.
conclusionsDespite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.
trial registrationAustralian New Zealand Clinical Trials Registry ( ACTRN12614000939695 ).
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.